机器人辅助与徒手经皮椎体成形术比较△（开放获取）

Robot-assisted percutaneous vertebroplasty versus conventional manual counterpart

摘要:

[目的] 比较机器人辅助与传统徒手穿刺下经皮椎体成形术（percutaneous vertebroplasty, PVP） 治疗骨质疏松性椎体压缩性骨折（osteoporotic vertebral compression fracture, OVCF） 的临床疗效。[方法] 回顾性分析2021 年1 月—2022 年11 月在本院行PVP 治疗的119 例单节段OVCF 患者的临床资料。根据入院时间，将患者分为两组，后期的75 例采用机器人辅助下PVP，早期的44 例采用传统徒手椎弓根外入路PVP。比较两组围手术期、随访及影像结果。[结果] 所有患者均顺利完成手术。机器人组在手术时间[(19.5±5.3) min vs (28.0±7.4) min, P＜0.001]、穿刺时间[(7.7±4.5) min vs (14.3±6.8) min, P＜0.001]、骨水泥注入时间[(7.3±1.6) min vs (8.7±1.6) min, P＜0.001]、术中透视次数[(24.2±4.1) 次vs (28.2±5.5) 次, P＜0.001]、住院天数[(8.2±2.9) dvs (12.3±4.4) d, P＜0.001]、一次性穿刺成功率[例(%), 67 (89.3) vs 27 (61.4), P＜0.001]、骨水泥注入量[(6.6±1.1) ml vs (5.4±1.4) ml,P＜0.001] 均显著优于徒手组。两组恢复完全负重活动时间的差异无统计学意义（P＞0.05）。随时间推移，两组VAS 评分、ODI指数均显著减少（P＜0.05），相应时间点，两组间上述指标的差异均无统计学意义（P＞0.05）。影像方面，与术前相比，末次随访时两组术后局部Cobb 角、椎体前缘高度均显著改善（P＜0.05）；相应时间点，两组间上述影像指标的差异均无统计学意义（P＞0.05）。[结论] 机器人辅助下PVP 治疗OVCF 更为安全，能缩短手术时间、减少术中透视、增加骨水泥注入量，可有效强化椎体。

Abstract:

[Objective] To compare the clinical outcomes of robot-assisted percutaneous vertebroplasty (PVP) versus conventionalmanual PVP in the treatment of osteoporotic vertebral compression fracture (OVCF). [Methods] A retrospective analysis was performed on119 patients who received PVP for single-segment OVCF in our hospital from January 2021 to November 2022. According to the time se-quence of admission, the patients were divided into two groups, 75 patients in the late stage received robot-assisted PVP, while 44 patientsin the early stage received conventional manual PVP through the extrapedicular approach. The data of perioperative period, follow-up andimaging were compared between the two groups. [Results] All patients in both groups had PVP completed successfully. The robot groupproved significantly superior to the manual group in terms of operation time [(19.5±5.3) min vs (28.0±7.4) min, P＜0.001], puncture time[(7.7±4.5) min vs (14.3±6.8) min, P＜0.001], bone cement injection time [(7.3±1.6) min vs (8.7±1.6) min, P＜0.001], intraoperative fluorosco-py times [(24.2±4.1) times vs (28.2±5.5) times, P＜0.001], hospitalization day [(8.2±2.9) days vs (12.3±4.4) days, P＜0.001], one-time suc-cess rate of puncture [cases (%), 67 (89.3) vs 27 (61.4), P＜0.001] and bone cement injection volume [(6.6±1.1) ml vs (5.4±1.4) ml, P＜0.001]. There was no significant difference in the time to resume full weight-bearing activities between the two groups (P＞0.05). With thepassage of time, the VAS and ODI scores in both groups significantly decreased (P＜0.05), whereas which were not statistically significantbetween the two groups at any corresponding time points (P＞0.05). As for imaging, the local Cobb angle and anterior vertebral body marginheight significantly improved in both groups at the last follow-up compared with those preoperatively (P＜0.05), however, there were no sig-nificant differences in the above image indicators between the two groups at any time points accordingly (P＞0.05). [Conclusion] The robotassistedPVP for OVCF is safer, with advantages of shortening operative time, reducing intraoperative fluoroscopy, increasing the amount ofbone cement injection, and effectively strengthening the vertebral body.